Provider Demographics
NPI:1205383130
Name:LIPPERT, BEVERLY J (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:J
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:JANE
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3555
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:PLAZA D #6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-927-3434
Practice Address - Fax:912-921-0982
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245057363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care